Quality Spine Care: Healthcare Systems, Quality Reporting, and Risk Adjustment

405 Pages·2019·7.19 MB·English

by  John Ratliff

Quality Spine Care
Healthcare Systems, Quality
Reporting, and Risk
Adjustment
John Ratliff
Todd J. Albert
Joseph Cheng
Jack Knightly
Editors
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Quality Spine Care
John Ratliff • Todd J. Albert
Joseph Cheng • Jack Knightly
Editors
Quality Spine Care
Healthcare Systems, Quality Reporting,
and Risk Adjustment
Editors
John Ratliff Todd J. Albert
Department of Neurosurgery Hospital for Special Surgery
Stanford University New York, NY
Stanford, CA USA
USA
Jack Knightly
Joseph Cheng Atlantic Neurosurgical Specialists
University of Cincinnati Morristown, NJ
Cincinnati, OH USA
USA
ISBN 978-3-319-97989-2 ISBN 978-3-319-97990-8 (eBook)
https://doi.org/10.1007/978-3-319-97990-8
Library of Congress Control Number: 2018957706
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To my wife, Carla Carvalho, and my children
Maya and Jessica. Their patience throughout
this process and the many, many other
commitments that have taken me sometimes
far from home has made everything I have
accomplished possible. I owe it all to them.
John Ratliff
To my children Stuart, Elliot, and Emily who
have taught me the Quality of Life and Love.
Todd J. Albert
I dedicate this work to my wife Rebecca and
my son Josh. Their love and support means
the world to me.
Joe Cheng
I would like to dedicate my work in this effort
to my wife Sharon and my children Jake,
Kieran, Carlie, and Anna for the time and
encouragement they gave me to pursue this
project.
Jack Knightly
Foreword
The provision of quality care is often assumed but infrequently delivered. Such is
perhaps more evident in the spine arena than in any other in clinical medicine. The
assumption of quality is a dangerous assumption indeed. The documentation of the
study of quality, on the other hand, provides a grounding, if you will, that provides
a foundation for the study quality and the palpable achievement of high quality.
Ratliff, Cheng, Albert, and Knightly have pieced together a masterful work that
addresses the many facets of quality spine care. They pursue the past, looking to
learn from prior experiences. They present metrics, methodologies, and strategies
that can be used to objectivize the assessment of quality. They go on to present and
analyze existing healthcare systems, in order to assess the current status quo and to
provide a spring board for continuous improvement via quality reporting, the coor-
dination and alignment of the variety of healthcare systems, and the operationaliza-
tion of systems on a single institution, as well as national, basis.
In the pages that follow, the keys to quality spine care optimization lie. The more
we all work with the same goal in mind, in an organized manner, the faster we will
achieve optimal value in the spine arena. Please read with an open mind and apply
with enthusiasm.
Cleveland, OH, USA Mike Steinmetz
Cleveland, OH, USA Ed Benzel
vii
Preface
I have always been fascinated by the business aspects of healthcare. It may come
from having spent the vast majority of my adult life working at academic medical
centers, where many of the day-to-day challenges of running an enterprise are kept
at arm’s length. Even in academics, though, practitioners face daily reminders of the
impact of insurance coverage, or lack thereof, on the capacity of patients to enjoy
high-value care. Coverage policies and restrictions on beneficiary hospital access
based upon whether or not a center meets a payer’s distinction as a “center of excel-
lence” all limit patient choices and influence patient care.
These soft approaches to rationing healthcare, through restricting choice and
controlling access, may have profound effects on our patients. Maintaining patient
access to care should be the primary goal of physician advocates in this space.
I learned the US system of healthcare finance through tutelage at the American
Medical Association’s Resource-Based Relative Value Scale (RBRVS) Update
Committee (RUC), with the mentorship of giants like Greg Przybylski, Rick Boop,
and John Wilson, after a supportive nudge from James Bean. Over many years, I
developed the skill set necessary to navigate the arcana of the RUC and to advocate
for neurosurgical patients. Concomitant with volunteering at the RUC, I was fortu-
nate enough to have two mentors who join me as co-editors on this text. Joe Cheng
contributed vastly to my understanding of coding and reimbursement and to my abil-
ity to teach these topics to others. Jack Knightly, following in the footsteps of thought
leaders like Robert Harbaugh and Dan Resnick, helped me understand the separate,
equally arcane system of quality improvement and quality reporting. Borrowing
from Eisenhower, Knightly refers to it as the “quality-industrial complex.” Last but
certainly not least, my other co-editor Todd J. Albert, with Alex Vaccaro and others
at Thomas Jefferson University, taught me the value of integrated systems and the
strength that orthopedic and neurosurgical physicians can wield when working
together.
I saw, as I started volunteering in both the RUC and neurosurgery’s Quality
Improvement Workgroup, how these two systems were coming together and how
quality would take a greater and greater role in healthcare finance and access.
Hence the impetus of this text. There are many textbooks that cover the technical
aspects of operative spine care. I know of none that provide surgeons with insight
into the equally challenging aspects of healthcare delivery and quality assessment.
ix
x Preface
I hope this volume will provide a succinct overview of a variety of aspects of qual-
ity as applied to spine care.
I am especially indebted to my international authors, who provide insights into
healthcare in China, Japan, England, Australasia, and India, and how quality is
assessed within their systems. I sought international authors to see how the chal-
lenges of quality assessment and healthcare finance are met in other countries—I
wondered if anyone else had come any closer than the USA to having this “figured
out.” I learned so much from reading their chapters and from reviewing the chal-
lenges faced in these disparate healthcare environments.
I hope you enjoy this text as much as my co-editors and I have enjoyed compiling
it. Our authors have done a phenomenal job of compacting a tremendous volume of
information into a concise 24 chapters. We hope you enjoy it.
Stanford, CA, USA John Ratliff
Acknowledgments
I would like to acknowledge first and foremost the contributions of my co-editors.
Their guidance and mentoring throughout my career has been invaluable. I would
also like to thank Dr. Iwasaki, for completing the Japan chapter with an unaccept-
ably short lead time. His dedication to spine care is exemplary. Finally I would like
to thank Alex Vaccaro for his friendship and guidance. Our authors have made this
textbook possible, and we are in their debt.
John Ratliff
xi
Contents
Part I Historical Aspects
1 Historical Aspects of Quality in Healthcare . . . . . . . . . . . . . . . . . . . . . 3
Omid R. Hariri, Ariel Takayanagi, T. J. Florence, and Arvin R. Wali
2 Quality and Standardization of Medical Education . . . . . . . . . . . . . . 15
Jonathan P. Scoville and Erica F. Bisson
3 The History of Quality Assessment in Spine Care . . . . . . . . . . . . . . . . 29
Eric J. Feuchtbaum, Catherine H. MacLean, and Todd J. Albert
Part II M ethodology in Quality Assessment
4 Choice of Quality Metrics for Assessment of the Spine Patient . . . . . 53
Taylor D. Ottesen, Kareem J. Kebaish, and Jonathan N. Grauer
5 Patient-Reported Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Melissa R. Dunbar and Zoher Ghogawala
6 Registries in Spine Care in the United States . . . . . . . . . . . . . . . . . . . . 75
Owoicho Adogwa, Joseph Cheng, and John E. O’Toole
7 Registries in Spine Care: UK and Europe . . . . . . . . . . . . . . . . . . . . . . 89
Bernhard Meyer, Ehab Shiban, and Sandro M. Krieg
8 Concepts of Risk Stratification in Measurement
and Delivery of Quality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Tejbir Singh Pannu, Virginie Lafage, and Frank J. Schwab
9 Risk Adjustment Methodologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Zach Pennington, Corinna C. Zygourakis, and Christopher P. Ames
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